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CDHB

Vomiting

Causes

• Visceral:
  • Organic disease of oesophagus/stomach/bowel.
  • Pseudo obstruction.
  • Mechanical - bowel obstruction/gastric stasis.
  • Acute abdomen.
  • Liver metastases.
• Toxic/metabolic:
  • Acute febrile illness/sepsis.
  • Ketoacidosis/uraemia/hepatic failure etc.
  • Drugs (e.g., digoxin, theophylline, cytotoxics).
• Neurological:
  • Vestibular/middle ear.
  • Increased intracranial pressure.
  • Cerebrovascular accident (especially brain stem).
• Other:
  • Pregnancy.
  • Excess smoking, alcohol and other addictive drugs.
  • Anticipatory.

Complications

• Aspiration pneumonia.
• Haematemesis (Mallory-Weiss tear).
• Oesophageal perforation (pain is a prominent feature).
• Malnutrition/dehydration.
• Electrolyte/volume depletion.
• Hypochloraemic alkalosis.

Treatment

Determine and treat the underlying cause. If antiemetics are indicated:

• Dopamine antagonists:
  • Metoclopramide 10 mg TDS PO, IM, IV, but higher doses may be required.
  • Domperidone 10 mg QID PO. Preferred initial antiemetic agent for patients with parkinsonism.
• Phenothiazines:
  • Prochlorperazine 5 - 10 mg TDS PO, IM, PR. (Tabs 5 mg, buccal 3 mg, injection 12.5 mg, PR 25 mg.)
• Cyclizine 25 - 50 mg TDS PO, IM, IV.
• Sedatives and hypnotics may be used.
• Ondansetron (for approved indications). May cause constipation.

Note: For vomiting in malignancy, refer to Management of Nausea and Vomiting in the Oncology section. For post-operative vomiting, refer to Management of Adult Post-operative Nausea and Vomiting (PONV).

Topic Code: 1411